Late Post-traumatic Epilepsy in Children and Young Adults : Impropriety of Long-Term Antiepileptic Prophylaxis and Risks in Tapering

Background: After traumatic brain injury, epilepsy affects up to 20Â % of children. It is a risk factor, for both clinical recovery and cognitive performance; therefore pharmacological therapy is advisable. Current guidelines recommend prophylaxis to be initiated as soon as possible and tapered 1Â week after trauma. However, no guideline exists for paediatric patients and the clinical practice is heterogeneous. Objective: In our institute, prophylaxis was routinely tapered 6Â months after trauma. Therefore we investigated whether this prophylaxis or its tapering influenced the development of post-traumatic epilepsy, together with several clinical-demographic factors. Methods: The study population comprised all patients with post-traumatic brain injury referred to this institute between 2002 and 2009 who consented to participate. Clinical, epileptological and pharmacological data were collected. The role of prophylaxis and several other predictors on occurrence of post-traumatic epilepsy was analysed through logistic regressions. Results: Two hundred and three patients (145 paediatric) were followed for 57Â months on average. Risk factors for epilepsy were past neurosurgery [odds ratio (OR)Â =Â 2.61, 95Â % confidence interval (CI) 1.15–5.96], presence of epileptiform anomalies (ORÂ =Â 6.92, 95Â % CI 3.02–15.86) and the presence of prophylaxis (ORÂ =Â 2.49, 95Â % CI 1.12–5.52), while higher intelligence quotient (IQ) was protective (ORÂ =Â 0.96, 95Â % CI 0.95–0.98). While evaluating possible different effects within and after 6Â months (tapering, for those under prophylaxis), we found that epileptiform anomalies (ORÂ =Â 7.61, 95Â % CI 2.33–24.93, and ORÂ =Â 8.21, 95Â % CI 3.00–22.44) and IQ (ORÂ =Â 0.96, 95Â % CI 0.94–0.98, and ORÂ =Â 0.97, 95Â % CI 0.95–0.98) were always significant predictors of epilepsy, while neurosurgery (ORÂ =Â 4.38, 95Â % CI 1.10–17.45) was significant only within 6Â months from trauma, and prophylaxis (ORÂ =Â 3.98, 95Â % CI 1.62–9.75) only afterwards. Conclusions: These results suggest that prophylaxis was irrelevant when present; furthermore its tapering increased the risk of epilepsy. Since the presence of epileptiform anomalies was the main predictor of post-traumatic epilepsy, such anomalies may be useful to better direct the choice of prophylaxis.